Development and Evaluation of Educational Materials for Primary Care on Familial Breast and/or Ovarian Cancer

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Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study

Purpose: Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods: A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results: Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10-1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00-16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26-46.75, vs 18 days, IQR 16-46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6-15.5) for non-IMV and 49.5 days (IQR 36.8-82.5) for IMV patients. Conclusions: Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19

Patient education, risk communication and informed choice

This thesis describes research carried out to explore the needs, expectations and experiences of the increasing number of women with a family history of breast cancer who present to primary care. This work was intended to inform clinical practice and policy, and to directly address women's needs where possible. Although a great deal of research has looked at the experiences of women with a family history of breast cancer in a specialist setting, when this work began, no research had yet been published on women's needs in primary care. This is particularly important, as general practitioners (GPs) are the first port of call, and often the main source of information, advice and support. A qualitative interview study was used for the preliminary work exploring women's subjective experiences of consulting primary care about a family history of breast cancer and understanding their primary care consultation needs (Chapter 2). This work was further elaborated upon using a prospective descriptive study to quantify the extent to which women shared the same views or experiences, and therefore, would benefit from certain changes in health care provision (Chapter 3). The qualitative and quantitative research showed that women's main primary care consultation needs were to discuss their risks of breast cancer with their GP and to receive verbal as well as take-home information. When this work was being carried out, no patient information was available suitable for a general population of women with breast cancer in the family who present to primary care. For this reason, a leaflet was developed based on women's information needs and the best available evidence (Chapter 4). The leaflet entitled Breast and/or Ovarian Cancer in the Family: Learning More about Your Risks and Options was evaluated with almost 200 women to ensure that it met their needs (Chapter 5). Over 90% of women were glad to have received the leaflet and felt that it provided the information they wanted to know. The implications of the work described in this thesis are that GPs could greatly assist their patients by acknowledging family history concerns as a legitimate reason for presenting to primary care, by providing verbal and take-home information and by inviting patients to return for future discussions if needed. Nationally accepted management guidelines for breast cancer family history and accompanying educational materials for use in primary care will also be instrumental in meeting patient needs and promoting informed choice in this new and difficult area of medicine.</p

Patient education, risk communication and informed choice: women with a family history of breast cancer who present to primary care

This thesis describes research carried out to explore the needs, expectations and experiences of the increasing number of women with a family history of breast cancer who present to primary care. This work was intended to inform clinical practice and policy, and to directly address women's needs where possible. Although a great deal of research has looked at the experiences of women with a family history of breast cancer in a specialist setting, when this work began, no research had yet been published on women's needs in primary care. This is particularly important, as general practitioners (GPs) are the first port of call, and often the main source of information, advice and support. A qualitative interview study was used for the preliminary work exploring women's subjective experiences of consulting primary care about a family history of breast cancer and understanding their primary care consultation needs (Chapter 2). This work was further elaborated upon using a prospective descriptive study to quantify the extent to which women shared the same views or experiences, and therefore, would benefit from certain changes in health care provision (Chapter 3). The qualitative and quantitative research showed that women's main primary care consultation needs were to discuss their risks of breast cancer with their GP and to receive verbal as well as take-home information. When this work was being carried out, no patient information was available suitable for a general population of women with breast cancer in the family who present to primary care. For this reason, a leaflet was developed based on women's information needs and the best available evidence (Chapter 4). The leaflet entitled Breast and/or Ovarian Cancer in the Family: Learning More about Your Risks and Options was evaluated with almost 200 women to ensure that it met their needs (Chapter 5). Over 90% of women were glad to have received the leaflet and felt that it provided the information they wanted to know. The implications of the work described in this thesis are that GPs could greatly assist their patients by acknowledging family history concerns as a legitimate reason for presenting to primary care, by providing verbal and take-home information and by inviting patients to return for future discussions if needed. Nationally accepted management guidelines for breast cancer family history and accompanying educational materials for use in primary care will also be instrumental in meeting patient needs and promoting informed choice in this new and difficult area of medicine

Screening for social determinants of health in clinical care: moving from the margins to the mainstream

Abstract Background Screening for the social determinants of health in clinical practice is still widely debated. Methods A scoping review was used to (1) explore the various screening tools that are available to identify social risk, (2) examine the impact that screening for social determinants has on health and social outcomes, and (3) identify factors that promote the uptake of screening in routine clinical care. Results Over the last two decades, a growing number of screening tools have been developed to help frontline health workers ask about the social determinants of health in clinical care. In addition to clinical practice guidelines that recommend screening for specific areas of social risk (e.g., violence in pregnancy), there is also a growing body of evidence exploring the use of screening or case finding for identifying multiple domains of social risk (e.g., poverty, food insecurity, violence, unemployment, and housing problems). Conclusion There is increasing traction within the medical field for improving social history taking and integrating more formal screening for social determinants of health within clinical practice. There is also a growing number of high-quality evidence-based reviews that identify interventions that are effective in promoting health equity at the individual patient level, and at broader community and structural levels

Patient education, risk communication and informed choice

This thesis describes research carried out to explore the needs, expectations and experiences of the increasing number of women with a family history of breast cancer who present to primary care. This work was intended to inform clinical practice and policy, and to directly address women's needs where possible. Although a great deal of research has looked at the experiences of women with a family history of breast cancer in a specialist setting, when this work began, no research had yet been published on women's needs in primary care. This is particularly important, as general practitioners (GPs) are the first port of call, and often the main source of information, advice and support. A qualitative interview study was used for the preliminary work exploring women's subjective experiences of consulting primary care about a family history of breast cancer and understanding their primary care consultation needs (Chapter 2). This work was further elaborated upon using a prospective descriptive study to quantify the extent to which women shared the same views or experiences, and therefore, would benefit from certain changes in health care provision (Chapter 3). The qualitative and quantitative research showed that women's main primary care consultation needs were to discuss their risks of breast cancer with their GP and to receive verbal as well as take-home information. When this work was being carried out, no patient information was available suitable for a general population of women with breast cancer in the family who present to primary care. For this reason, a leaflet was developed based on women's information needs and the best available evidence (Chapter 4). The leaflet entitled Breast and/or Ovarian Cancer in the Family: Learning More about Your Risks and Options was evaluated with almost 200 women to ensure that it met their needs (Chapter 5). Over 90% of women were glad to have received the leaflet and felt that it provided the information they wanted to know. The implications of the work described in this thesis are that GPs could greatly assist their patients by acknowledging family history concerns as a legitimate reason for presenting to primary care, by providing verbal and take-home information and by inviting patients to return for future discussions if needed. Nationally accepted management guidelines for breast cancer family history and accompanying educational materials for use in primary care will also be instrumental in meeting patient needs and promoting informed choice in this new and difficult area of medicine.<p